Code of Massachusetts Regulations 244 CMR - BOARD OF REGISTRATION IN NURSING
244 CMR — Board of Registration in Nursing
(Massachusetts Code of Regulations)
244 CMR contains the regulations that govern the licensure, practice, scope of practice, professional conduct, continuing education, and discipline of nursing professionals in the Commonwealth of Massachusetts.
It is promulgated by the Board of Registration in Nursing (“the Board”) under authority granted by the Massachusetts Legislature to protect public health, safety, and welfare by ensuring the competence and accountability of nurses.
1. Purpose and Scope of 244 CMR
The regulations in 244 CMR are designed to:
✔ Establish standards for nursing education and licensure
✔ Define scope of practice for various nursing roles
✔ Set requirements for continuing education and competency
✔ Identify professional conduct expectations and prohibitions
✔ Provide procedures for investigation and discipline of licensees
These rules apply to all nurses practicing in Massachusetts, including:
Registered Nurses (RNs)
Licensed Practical Nurses (LPNs)
Advanced Practice Registered Nurses (APRNs) (where specified)
Nurse license candidates, interns, and students to the extent specified
2. Definitions (244 CMR § 1.00)
Key definitions establish what activities and titles require regulation:
Registered Nurse (RN): A person licensed to practice professional nursing.
Licensed Practical Nurse (LPN): A person licensed to provide basic nursing care under supervision.
Practice of Nursing: The performance of services requiring substantial specialized judgment and skill based on nursing knowledge.
APRNs: Includes nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists where identified.
These definitions determine who must be licensed and what activities are regulated.
3. Licensure Requirements (244 CMR § 2.00)
A. General Criteria
To be licensed as an LPN or RN, an applicant must:
✔ Be of good moral character
✔ Satisfy education requirements from an approved nursing program
✔ Pass a national licensing examination
✔ Submit a complete application and applicable fees
Each requirement ensures minimum competency and ethical suitability to protect patients.
B. Approved Nursing Education
The Board approves nursing education programs based on:
Accredited curriculum
Appropriate clinical experience
Competency‑based learning outcomes
Graduates of approved programs are eligible to sit for the licensing exam.
C. Examination Requirements
Registered Nurses typically take the NCLEX‑RN
Licensed Practical Nurses take the NCLEX‑PN
Passing these exams demonstrates minimum competence required for safe entry into practice.
D. Endorsement (Out‑of‑State Licenses)
Individuals licensed as nurses in other states may seek Massachusetts licensure by endorsement if:
✔ Their credentials are substantially equivalent
✔ They are in good professional standing
✔ They meet the Board’s requirements
This facilitates mobility of qualified nurses while maintaining standards.
4. Scope and Standards of Practice (244 CMR § 3.00)
A. Registered Nurse (RN) Scope
RNs engage in:
Assessment and nursing diagnosis
Planning, implementing, and evaluating nursing care
Delegation and supervision of appropriate tasks
Clinical judgment and decision‑making
RNs must practice within the boundaries of their education, training, and competence.
B. Licensed Practical Nurse (LPN) Scope
LPNs provide:
Basic nursing care
Assistance with patient comfort and activities of daily living
Tasks delegated by an RN, physician, or authorized prescriber
LPN practice is supervised or directed by an RN or other authorized health professional.
C. Advanced Practice Registered Nurse (if applicable)
Where regulations specify APRN scopes, APRNs may:
Perform advanced assessments
Prescribe medications (if authorized)
Manage complex patient care
APRN scopes are defined in statute and may be supplemented by Board rules.
5. Standards of Professional Conduct (244 CMR § 4.00)
The regulations outline expected behavior and boundaries, including:
A. Ethical Obligations
Nurses must:
Provide care with compassion and respect
Maintain patient confidentiality
Follow professional and legal guidelines
B. Delegation and Supervision
Nurses must:
Delegate only tasks appropriate to the skill and scope of the recipient
Supervise care they delegate
Accept delegation only when qualified
C. Documentation and Records
Accurate, timely, and complete documentation in patient charts is required.
6. Continuing Education and Competency (244 CMR § 5.00)
Most nurses must complete a specified number of continuing education (CE) hours within each renewal period.
Requirements generally include:
✔ Courses relevant to current nursing practice
✔ Approved sponsors or acceptable CE providers
✔ Documentation retained in case of audit
Continuing education ensures ongoing competence as healthcare evolves.
7. Uniform Standards of Professional Conduct (Detailed)
244 CMR identifies more specific prohibited behaviors, such as:
❌ Practicing beyond one’s scope
❌ Failing to safeguard patient dignity and rights
❌ Misrepresentation of credentials or skills
❌ Substance abuse that affects safe practice
❌ Abusive or discriminatory actions
Such conduct exposes a nurse to disciplinary action by the Board.
8. Discipline and Enforcement (244 CMR § 6.00)
A. Grounds for Discipline
The Board may investigate and discipline nurses for:
Violations of 244 CMR or nursing laws
Professional misconduct
Negligence or incompetence
Fraud, misrepresentation, or deceit
Criminal conviction related to practice
Substance abuse affecting practice
B. Complaint and Investigation
Complaints may be filed by:
Patients
Employers
Colleagues
Government agencies
The Board reviews and may open an investigation.
C. Adjudication and Due Process
If probable cause exists, the Board may:
✔ File formal charges
✔ Provide notice to the licensee
✔ Offer a hearing before an administrative judge
✔ Allow the nurse to present evidence and defense
Due process ensures fairness in enforcement.
D. Sanctions
Sanctions may include:
Reprimand
License suspension
License revocation
Probation
Fines
Required remediation or continuing education
Sanctions protect the public and rehabilitate the practitioner when appropriate.
9. Administrative Responsibilities
Nurses must also comply with administrative requirements:
A. License Renewal
Nurse licenses must be renewed on schedule, usually every two years, along with:
✔ Payment of renewal fee
✔ Attestation to CE completion
Failure to renew may require reinstatement.
B. Reporting Requirements
Licensees must notify the Board of:
Changes in address
Disciplinary actions taken in other states
Convictions or guilty pleas involving practice
Accurate reporting supports Board oversight.
10. Practical Implications of 244 CMR
For Nurses
Licensure guarantees legal authority to practice.
Maintaining licensure involves ongoing education and compliance.
Ethical conduct and record keeping are mandatory.
For Patients and Employers
Patients gain assurance of competence and accountability.
Employers rely on standard training and legal practice standards.
11. Summary
244 CMR — Board of Registration in Nursing:
✔ Sets educational and licensing standards for RNs and LPNs
✔ Defines scope and limits of nursing practice
✔ Requires continuing competency through education
✔ Establishes professional conduct rules
✔ Provides disciplinary procedures to protect the public
These regulations ensure that nursing practice in Massachusetts is performed by qualified, ethical professionals committed to safe, competent care.
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